Comments (169)

• 6

  John Hayden - June 17, 2019

  Were Hemostatic agents/gauzes purposefully left out? I saw only a cursory mention of it under Z-Pack Gauze and given the different brands and types it seems like an odd thing to not get into detail about on an otherwise very detailed list.

   
  • 13

    Tom RaderStaff - June 17, 2019

    Sort of. We avoid most powdered agents — Celox A is the only one we like and is included in the home supplies list. We explain in the articles that hemostatic-impregnated gauze is a fine upgrade if you want to spend the money on it, but we don’t specifically recommend it for most people because 1) it only shaves a few minutes off the time needed to control a wound, 2) it’s worth having gauze without expensive hemo that you can use on non-bleeding needs, and 3) untrained civilians overestimate the value of impregnated gauze and get lazy about the basics (like well-aimed direct pressure). But it’s absolutely fine if you want to carry some hemo gauze!

     
• 6

  Kaizenjutsu - August 4, 2019

  It looks like you’re using a Condor tear away med pack. Could you do a post about how you loaded everything in there?

   
• 6

  Kaizenjutsu - August 4, 2019

  It looks like you’re using a Condor tear away med pack. Could you do a post about how you loaded it with all the level 3 items?

   
  • 13

    John AdamaStaff - August 4, 2019

    We’ve already started working on a post about how to organize/pack the gear! Keep an eye on the newsletter or facebook group for when we publish it. Thanks for the suggestion.

     
  • 7

    Arterial Red - August 6, 2019

    Ack! I just saw this after my post!
    Will keep an eye out for the packing article. Thanks and keep up the good work!

     
  • 7

    John AdamaStaff - August 6, 2019

    No worries, it’s always helpful to hear what the community wants. Helps us choose from the mountain of options to work on next.

     
  • 6

    Lowell - April 26, 2021

    @John is there a Facebook group?? Or did you mean page?

     
  • 2

    Gideon ParkerStaff - April 27, 2021

    Hi Lowell, 

    To answer your question, we do have a Facebook page.

    Here’s a link to it: https://www.facebook.com/HomeOfThePrepared

     
  • 5

    Glock22 - August 8, 2019

    I’ll look forward to this perspective.

     
  • 6

    Yasmin - September 11, 2020

    Did you folks publish the packing article? I’m having a hard time finding it and I’m struggling hard with how to keep everything organized and compact yet streamlined.

     
• 5

  Arterial Red - August 6, 2019

  Hi all!
  I’m almost done putting together all the gear for a level 3, but space in my MOLLE pouch is running out! What sort of witchcraft are you using to get all that in there? Any chance of getting a ‘how-to’ guide or video on packing this kit?
  Thanks for the article!

   
  • 7

    Kaizenjutsu - August 7, 2019

    What pouch are you using? I originally thought the pictured one was a Condor model but after more searching I found the correct one. It’s very similar to the Condor or another model from Orca. I imagine the packing techniques should work for all of those models.

     
  • 8

    Tom RaderStaff - August 7, 2019

    Hi Kaizenjutsu (and @Arterial Red), the pouch we used for this (and that we all have) is the Fox Outdoor First Responder Active Field Pouch (https://theprepared.com/pic….

    I have 6 of these completely assembled for my personal BOBs and GHBs. They are definitely tightly packed, but many of the items compress well. The medications are kept in a separate small Pelican box to protect them from crush damage (and that box is not in the Fox bag).

    There are some knock-off bags that are a little smaller which might be more challenging to fit stuff.

     
  • 7

    Kaizenjutsu - August 7, 2019

    Yes, that’s the one I figured you had. I have the Condor model which allegedly has the same dimensions save 0.5” depth – for a soft bag I can’t see mattering that much. Using the separate Pelican makes the packing situation clearer (though I’m hoping to cram everything in the pouch), but I’m still struggling to see how the relatively massive Recon aluminum splint fits in there.

     
  • 9

    Tom RaderStaff - August 7, 2019

    Hi Kaizenjutsu,

    You have to refold the splint for it to fit inside the Fox bag. As it ships it is too tall. I stow it in that sleeve in the rear side (nearest the back of the pouch) and fold it so that it takes up as much of the internal height as possible. It will be one width thicker than normal, and you do have to make sure it is tight and flat.

    Another thing that can help with space is taking some of the other components out of the packaging like the cravats — especially the large one. And don’t be shy about folding and squishing things like the gauze pads. If the Coban has a rigid tube in the middle, slide it out.

    As John mentioned in another thread we will show how we pack ours.

     
  • 7

    Kaizenjutsu - August 7, 2019

    It seems painfully obvious in retrospect, but I suppose I should have bought the flat instead of rolled splint. The article link picture is of the rolled one but the flat makes much more sense. I suppose I can just unroll and refold it, right?

     
  • 5

    Tom RaderStaff - August 8, 2019

    Yes, you can totally unroll and fold it. In fact that might be a little easier starting with the rolled one since you don’t have to overcome existing folds that may be a couple of inches off. Fortunately aluminum splints are pretty easy to manipulate.

     
  • 8

    Kylie - March 27, 2020

    Do you mind sharing your specific Pelican box you use, please? What is the pros of separating out items into two bags? Thanks for your help! This is super helpful!

     
  • 5

    Tom RaderStaff - March 27, 2020

    I like the Pelican 1040 for its size.  It holds the meds and creams for one kit well: https://theprepared.com/pick/tp-kb-pelican-1040-amzn/

    Depending on how I am loaded out, I will separate out the Level 1 items for quick and easy access.  I like to carry those items in an ankle holster, and Level 2 and 3 in my pack when I am on foot.  In my vehicle I have a single bag that holds all of the items.

     
• 4

  Mavis Gary - August 15, 2019

  For most people Ibuprofen or Naproxen (Aleve) are ideal for occasional/first aid use for aches and pains. I appreciate that you noted they aren’t good for people with established kidney or GI disease. You should also note that even a small overdose of Tylenol can cause irreparable liver damage. A significant number of people die from this every year. It should not be used at all by people who drink alcohol and never for a hangover. New to the site, enjoying your content, thank you!

   
  • 7

    John AdamaStaff - August 15, 2019

    Thanks Mavis! Hope to see you around.

     
• 7

  SpeedRat21 - August 24, 2019

  I’m a little surprised that aspirin is so low on the list due to its use treating/preventing an impending heart attack. I know everyone has their differences of opinion, largely based on variations in training and experience, but aspirin is such a simple treatment and heart attacks can happen anywhere or anytime –even before a SHTF scenario–that I would always recommend having aspirin in any first aid kit of any level.

   
  • 10

    Tom RaderStaff - September 3, 2019

    The “Level 1” items were very strongly debated, and aspirin simply didn’t make the cut for that level of the kit. It was ultimately a balance between utility and solvability of medical problems. Aspirin, while helpful during a heart attack, is not a solution to the problem, and is a weaker solution for other uses. The items in “Level 1” are direct solutions for one or more problems. That said, pills are light and it is up you to decide what goes in your kit and what priority you place on them.

    FWIW, our team that argued and debated this included ER doctors and experienced medics from a variety of backgrounds. The consensus on the placement of items used a “would you rather have X or Y” approach which helped sort the items to their current places.

     
  • 6

    DocOnes - April 3, 2020

    I bet that was an interesting and “lively” debate.

     
  • 8

    Lowell - January 22, 2021

    Can you expand on why aspirin doesn’t “solve the problem” of a heart attack? Certainly you should still get to a hospital if you can, but that’s the case for most things in this list, right? A tourniquet doesn’t “solve the problem” in that you still need to get to a hospital, but it’s a heck of a lot better to have than not, same as aspirin for a heart attack, no? 

     
  • 9

    Tom RaderStaff - January 23, 2021

    Hi Lowell!  The problem in a heart attack is blocked blood vessels.  The aspirin helps reduce clotting–clotting makes the problem worse–and buys time to get to the hospital and into a cath lab to solve the problem (which could be a stint or a bypass depending on the severity of the block).  That is not something you can manage in the field.  

    A tourniquet is a little different in that it buys you time to locate and stop the bleed with well-aimed direct pressure (which is the definitive way to stop bleeding).  In most cases, a tourniquet can be discontinued in favor of a pressure dressing or something that does not affect the entire limb.  Obviously, there are a few injuries that require a tourniquet to be left on (and then a trip to a hospital), but in our context, we want to try and remove a tourniquet as soon as possible, and can actually solve some problems in the field.

     
  • 8

    Lowell - January 23, 2021

    Oh interesting! Thank you so much for your response Tom!

     
• 3

  Biólogo Anónimo - September 4, 2019

  I would totally include at least one hydrocolloid dressing/pad. They are amazing for treating ulcers, blisters and burns.

   
  • 7

    John AdamaStaff - October 4, 2019

    What would you remove from the list to make room for those?

     
  • 6

    Biólogo Anónimo - October 5, 2019

    Nothing. The main advantage of those pads is that they are very thin, lightweight and completely moldable. On top of being self-adhesive – and requiring no bandaging – you can also cut them into tiny pieces to suit any kind of wound at any angle. A single pad the size of an standard weave pad can be cut several times to cover several wounds.

    You can fold them and fit them almost anywhere. You don’t need to sacrifice anything to add them to your kit unless your kit is so full of stuff it’s ready to burst, but if I were forced to replace something, just for the shake of the argument, I would remove a few band-aids because you can cut the pad to perform the exact same function of a band-aid if necessary.

    I speak from personal experience. My grandmother suffers from constant venous ulcers in her legs due to clotting problems and these little things are a lifesaver.

    Before, we used to spend a lot of bandages, tape and pads just for a single wound and those would need daily replacement. Furthermore, the bandaging only exacerbated the poor blood flow problem, but one of those hydro-colloid pads can be cut to be used 4-5 times before you have to get a new one.

     
• 5

  sdup - October 7, 2019

  This is such a great resource. Thank you! Thank you! Thank you! 🙂

  I’m considering leaving some form of this kit (maybe even Level 3) in each of our two vehicles…
  I live in S. Texas. Should any consideration be given to heat and storage in a car? Or, are there specific items that are more susceptible to heat than others? TY!!

   
  • 6

    Tom RaderStaff - October 7, 2019

    Glad you are enjoying the article!

    I live in New Mexico and have Level 3 kits in each of our vehicles (and our off-road trailer). The risk from damage is just to the medications. You want to keep them as cool and dry as possible and I do this by keeping all of our kits out of direct sun.

    Medications are kept in small pelican case. One of the reasons we recommend and favor tablet forms of the medications is because they typically survive temp better. That said, I do inspect and rotate the medications in the car twice a year, discarding anything that looks/smells suspect.

    Also, it is helpful to put creams/unguents (petroleum jelly, hydrocortisone, etc) in separate ziplocks. That way if one does get too hot and leaks, it doesn’t get all over everything else.

     
  • 5

    Scott Byron - November 19, 2019

    I just wanted to ask about storing meds in your car and you’ve answered most of my queston. I especially dig the idea of keeping creams, etc in ziplocs. What about winter time, though? Any specific reccomendations?

     
  • 7

    Tom RaderStaff - November 19, 2019

    Most creams and unguents are generally fine in the cold–they just get less pliable.  The small tubes we recommend can be easily rewarmed with body heat.

    If you want to reduce the chance of freezing, wrap them in some of the warming layers you should have in your car preps (wooly hat, fluffy socks, down jacket, etc).

     
• 7

  Sarah - October 9, 2019

  Great list thank you – is there going to be one for Homesteaders *after* SHTF so there will be no hospitals or ER room. Weight and storage not an issue then.

   
  • 6

    John AdamaStaff - October 11, 2019

    That’s why we split off a separate list for home supplies. Link in the intro and here: https://theprepared.com/hom… — hope helpful!

     
• 6

  sdup - October 9, 2019

  I’d like to put my “vote” in for a packing post too. I bought the Condor pack (which I’m now 2nd guessing), and as supplies come in from Amazon, I’m beginning to see I’m going to have a problem packing. Additionally, I’d love to see how medications are dealt with… using “on the go” sizes, re-packaging, etc??? Thanks again for all the work you guys put in to this. Really is amazing!

   
  • 7

    John AdamaStaff - October 11, 2019

    So happy it’s helpful! And thanks for the vote, we’ll definitely do it soon given the interest. I just repacked my personal kits with the help of some of these experts, and it was tight getting it all together, but did work. My problem was babying the med supplies too much, where the pros seemed to rough handle it.

    Meds are always preferred in solid pill form. As long as they stay dry, protected (eg. from crushing), and organized within the space you have, that’s good enough. But we prefer to re-package them into a small Pelican box (or some other small hard-sided organizer), as you can get the most pills in the smallest amount of protected space, while still being organized.

     
  • 4

    sdup - October 19, 2019

    I totally figured out my packing problem… bought a bigger bag! 🙂 Hate admitting defeat, but it’s all in and tidy-ish. Sort of.

    I still need to pack OTC meds. Taking my wife & threes young kiddos into account, the list has grown. Also grappling with quantities for each med. The travel tubes are too small (don’t hold enough) and the smallest “bottles” don’t pack well.

    Are people re-packaging pills into small ziplocks (or something else) before putting into the hard case? And are you guys able to fit the case into the med bag or is it packed separately? Thanks again!!!

     
  • 4

    John AdamaStaff - October 21, 2019

    Glad you got the bag worked out. It’s okay to carry extra meds because of your family, but you can’t be the pack mule for everyone!

    Yes, many people (incl most of us) repackage pills and other potentially leaky things (creams etc) into small ziplocks/containers which are then organized in a hard case. Try these https://theprepared.com/pic…

    We store the pill case separate from the med bag, mostly due to space limitations on a full level 3 bag + optimizing for the kinds of “I need it right now!” stuff in the med bag + keeping dirt/blood/etc away from the meds when dealing with urgent trauma.

     
  • 6

    skipdup - March 15, 2020

    Many of the OTC meds are individually blister packed (dye-free benadryl, many/most of the kids “dissolving” allergy & cold meds, etc).  Makes packing timely difficult.  I’ve tried researching, but not finding any answers…

    Is it OK to repackage this kind of meds?  I assume they’re blister packed for a reason…  Is it that exposure to “air” degrades them?  They stick together?  Break easily?  Thank you!!

     
  • 4

    Friend of the Pod - March 15, 2020

    I made the same assumption you did, but used scissors to cut out each individual blister to within maybe 1/8″ of the blister itself. Removing the excess packaging material made them much smaller and easier to pack.

     
  • 8

    Tom RaderStaff - March 19, 2020

    Blister packing is typically used to protect from environmental issues (like humidity) and to package a single dose.  If it is packaged that way it is best to keep it that way.  You should be able to trim it though, so long as you don’t break the seal.

    I try to select medications that are in bottles as I normally buy in bulk, and then repackage into small baggies.  In general, I also try to get medications that are in tablet form since they are less susceptible to damage.  I further protect them by putting them in a hard case.

     
  • 7

    AmazonianDoc - October 31, 2019

    Same here! Definitely want to see a tutorial on packing.

     
  • 7

    Scott Byron - November 19, 2019

    That’s a great idea!

     
• 9

  Devin Suttler - October 18, 2019

  Amazing article thank you so much!

   
• 6

  Arterial Red - December 4, 2019

  Hey all,

  Finally got 2 level 3 kits completed! One for my vehicle and another for my On Hand For Unexpected Circumstances Kit bag. Found some plastic vials on amazon that are great for storing the needle and thread in alcohol. Side note – dyed thread will bleed color into the alcohol.

  Cheers!

   
  • 8

    John AdamaStaff - December 4, 2019

    Awesome! Feels good to get major preps done. Good tip on the dyed thread (besides, you’d also want to avoid putting dyes etc into your body without reason.)

     
  • 5

    Olllddd Corpsman - April 22, 2020

    “some plastic vials on amazon”  Is it possible to get a link?  I have a hard time trusting vendors’ descriptions.  I figure if you’ve had hands on, at least you’ll have an opinion on the quality.

     
  • 4

    Arterial Red - April 23, 2020

    Here ya go:

     
• 5

  Simon - December 12, 2019

  Good article with some excellent advice and recommendations, but….

  Cool operators wear black gloves? Really? If you’re working at night, blood does not show up on black gloves unless your lighting is excellent. Unless you are a tactical operator (which I understand some are – I have been) blue or white gloves are the way forward.

  You have also made no mention of information that might be needed by medics when handing a casualty over. Again, I understand that some of the guys on here are paramedics but for those who are not, information such as the time the incident occurred, what was the mechanism of the injury etc is important.

   
  • 15

    John AdamaStaff - December 12, 2019

    Thanks for the comment. The black gloves thing was tongue in cheek 🙂 And you’re of course spot on about the importance of knowing what to communicate to professionals, but this article is just about the list of items, not as much what to do with them. That kind of advice is in posts like how to use a tourniquet https://theprepared.com/survival-skills/guides/tourniquet/

     
  • 8

    DocOnes - April 3, 2020

    I completely agree with Simon on medical communications.

    I may be newer to this site, but I am also extremely experienced in both tactical medicine and natural disaster recovery. I truly believe that every MED kit needs a minimum of a charcoal pencil and piece of paper. I have made over 15 of these kits for myself and family members. I won’t make them if the family member won’t buy the NARP Triage Card. They rarely seem to think it’s necessary.

    As a paramedic, if I bring a patient to a triage area and tell them my opinion, they listen, even if I’m not in uniform. That happened during the 2013 Moore Tornado. Several other patients who were brought by non-professionals, however, seemed to be lower in the triage than they should have been. Preference being given to patients coming from providers. It was not intentional, but it happens. This phenomenon is discussed in several after action reports from natural disasters. I don’t think these are minor mistakes.

    This phenomena may be avoided if you are partially treated with the high quality gear mentioned in these lists. It will be recognized by medical providers at an ER or field triage center.

    I do believe a triage card is necessary. I recommend the one from NARP, but it is bulky. There may be slimmer options on the market today. I don’t recommend that a non-professional make a triage category decision, but when you get to the triage location, hand it off to a professional, show them your work and ask them to pick the category. This gives them a vast amount of info to make the decision correctly.

     
  • 7

    Olllddd Corpsman - April 22, 2020

    Tag or not, I personally think it’s how you communicate the info.  If your report is bottom line up front and covers the necessities concisely, pros tend to listen.

    Of course, the .gov supplied all of mine, but I also come from the days with things like “M” and “T” on the vics forehead…

    Edited to add: “Combat Casualty Card  $31.99”  Actually laughing here.  Yes I’ve worked triage in mass casualty situations.  I’ve also trained and worked as a medical regulator – the person who has to decide where that patient is sent.  I’ve directed evac on patients from Asia to Brooks Burn Center  – the only stop – at an Air Force base to be transferred to a medical transport aircraft. To field hospitals – B Med. To Army and AF Hospitals.   To Aircraft Carriers. OK, not so laughable.  Looking further, at least Amazon gives some hope, since prices seem to be from $1-$3 each.

    Yes, that’s the type of info we used.  But when a patient hit our triage we immediately did an exam not only to verify the info, but to see if the Corpsman missed anything.  Most of you here probably know from experience, when you’re out in the dark in rain and mud, it an’t easy.

     
  • 7

    John AdamaStaff - April 23, 2020

    @Tom Rader was a Corpsman, I’m sure knows those situations well.

    Do either of you @Doc @Old know of a slim triage card/product that would be a good addition? Because of how infrequently it would be used, we’d definitely want to go slim and cheap.

     
• 10

  ReadyPlayer - December 20, 2019

  This list is amazing. Makes things so much easier for people like me that don’t know where to start, or cannot untangle all the different tidbits you can find online. Mega kudos! Looking fwd to many more articles like this one!

   
• 4

  Clark Thompson - January 3, 2020

  I’m going to assume that the #1 thing I’d put on this list (duct tape) is missing because it’s considered not just a medical supply. That said, duct tape should be on this list: it’s sterile (enough) it holds on any of the other bandages, it can be used to make wound coverage of every size, and like all the best emergency tools, there’s a lot of other uses. Second, as long as you’ve got duct tape I’d add cyanoacrylate (Crazy) glue which can be used in place of sutures, can reinforce butterflies, and again has a whole bunch of non medical emergency uses. Further, I’d ditch the chest seals in favor of Saran Wrap. Saran Wrap plus duct tape on three sides will do what chest seals will at much lower price, plus again much wider alternative utility. Like keeping flies off of bandages… last, I’d swap the immodium placement with the pepto bismol. Immodium just stops, while pepto cures. Having had dysentery a number of times, trust me, pepto is what you want to start with, immodium only if that doesn’t stop it fast enough.

   
  • 5

    John AdamaStaff - January 8, 2020

    Saran wrap is already on the list (#20 overall). You can DIY chest seals as you described, but it won’t be as good as a proper product: https://theprepared.com/gear/reviews/chest-seal/

    You can use crazy glue if you need to, but again it’s not as good as the real thing: https://theprepared.com/survival-skills/guides/close-wound/

    Duct tape is not included because, just like the above, it can work if needed but is not preferable. And it’s included in the general emergency kit list (as you expected): https://theprepared.com/bug-out-bags/guides/bug-out-bag-list/

     
  • 7

    Clark Thompson - January 8, 2020

    Thanks, missed the Saran Wrap/plastic wrap—btw brand does matter, I wouldn’t use store brand plastic wrap.) I’m still going to say duct tape should be high on the list. Maybe not ideal, but if I had just gauze pads, Saran Wrap and duct tape I could bandage almost anything.

     
  • 2

    Trace Adams - December 1, 2021

    Duct tape leaves a messy sticky residue that’s very difficult to clean off especially on damaged skin. Medical tape avoids that. But military 100mph tape or Gorilla Tape works well, and can double for other uses also, and avoids the sticky residue.

     
• 4

  Friend of the Pod - January 21, 2020

  This article is 100% the best resource I’ve found for guidance on putting together an emergency medical kit. Likewise, this entire site is amazing. Many thanks to all of you!

  One question: for the listed OTC medications, what would be reasonable quantities to carry? Can you give us a general rule-of-thumb, like “[at least] X number of adult doses”?

   
  • 6

    John AdamaStaff - February 5, 2020

    Thanks so much for the kind words! As a layman I found it very helpful too.

    Although it may change based on your personal needs and kit space, the general rule of thumb is 24 doses. Because many non-antibiotics recommend dosing for six days, and at four doses a day, that’s 24. Some people go lighter/smaller than that at 12 doses. Or they mix and match, eg. more doses of things they know they use more, and less doses of “nice to haves.”

    Antibiotics are generally prescribed as a ten day course at twice per day.

     
  • 6

    Friend of the Pod - February 6, 2020

    Outstanding. That’s very helpful. Thanks for the reply, John!

     
  • 7

    Alicia - July 9, 2020

    Agreed! Thanks @Friend of the Pod for asking and @John Ramey for answering this one.  I had the same question.  This also explains the large size of the protective box.  I’m still trying to lighten up the load while still including everything.  Not happening as you’ve thought it all through so well.

     
• 6

  TraceContributor - February 9, 2020

  Outstanding article! You guys break things down exactly like I have preached, though more succinctly! Also great explanations about how and why.

  And to those complaining about lack of duct tape on the list, I don’t like duct tape on/near wounds. The sticky residue is difficult to remove for any dressing changes, also the stick residue makes using it in place of mole skin on the feet problematic. That being said, I think nice wide tape is a good idea — instead of duct tape consider 100 mph tape (military) or Gorilla Tape. Also kinesiology tape works great to prevent foot blisters, it sticks much better than mole skin which has a tendency to peel off.

   
  • 7

    John AdamaStaff - February 10, 2020

    Thanks!

     
• 7

  Ironclad Amoeba - February 19, 2020

  Are you aware of claims that non-steroidal anti-inflammatory drugs (ibuprofen, naproxen, aspirin…) could worsen infections, potentially to a severe degree? If so, what do you think of them?

   
  • 12

    Tom RaderStaff - February 20, 2020

    Like all medications, it is important to use them when appropriate.  There is some research out there showing that existing group A streptococcal soft tissue infections can be accelerated by non-selective NSAIDs (the ones you mention).  But it is for a very specific class of infections.

    There is also research demonstrating that NSAIDs have positive effects on treating sepsis.

    In general, the benefits of using NSAIDs correctly (for the purposes they are intended) outweigh the risks.  A person is far more likely to have a condition that can be assisted with NSAIDs than the converse.

     
  • 8

    Ironclad Amoeba - February 20, 2020

    Alright, thank you for clearing that out. Keep up the great work.

     
  • 1

    TraceContributor - December 1, 2021

    Yes! Exactly.

     
• 7

  Friend of the Pod - February 22, 2020

  One small suggestion… As I’ve been accumulating the recommended medications it occurred to me that off the top of my head I really have no idea what the dosing instructions, contraindications, and warnings are for the medications I’ve rarely used. Because of that, I cut off the backs of the boxes they came in (where all of that information is printed), and put them in the bottom of the pelican case under the baggies for quick reference. They take up next to no space, and now I don’t have to worry about using a medication improperly out of ignorance.

   
  • 9

    John AdamaStaff - February 22, 2020

    Great idea! We have to avoid talking about doses etc due to legal reasons.

     
• 8

  Jared Genzel - March 4, 2020

  What do you guys think about carrying Narcan (Naloxone) in your IFAK? Opioid overdoses are a big problem in a lot of areas.

   
  • 9

    Friend of the Pod - March 5, 2020

    I curious to hear the answer from the experts myself. That said, my instinct is that although it might make sense in an EDC IFAK, I don’t think it makes sense in the context of a bug out bag IFAK. Just my two cents as another layman.

     
  • 11

    Tom RaderStaff - March 5, 2020

    It is not on our list since we don’t recommend opioids as part of the list, and overdoses aren’t typically something you “stumble upon” in a survival/bugout context.  You are more likely to encounter an overdose in a professional context (at a point when you can reverse it with Narcan).

    That said, you can totally customize the contents to your needs.  And if you have added opioids to personalize your bag for pain management, Narcan would be a good pairing.

     
  • 6

    John AdamaStaff - March 5, 2020

    In addition to the other answers, here’s some takes on this exact topic when we did a community Q&A with the experts: https://www.reddit.com/r/preppers/comments/c1b6m2/were_seven_er_doctors_wilderness_medicine/erc4xaf/

     
  • 5

    TraceContributor - March 6, 2020

    By definition your IFAK is your Individual First Aid Kit. It is for you. If you get hurt, you or others should use it on you. Likewise, especially in the military, if someone else is hurt you use their kit to help them.

    The biggest goal with an IFAK is to keep it as small and portable–thus more likely for you to actually have with you–as possible. If you start adding assorted “nice to have”/boo-boo treatment type stuff it quickly becomes to big and then it gets left behind.

     
• 7

  SpaceSnaxxx - March 8, 2020

  Does anybody have good suggestions for medical bags that can be carried on the thigh? Lots of options on Amazon, but I’d like some Prep-spective.

   
  • 5

    SpaceSnaxxx - March 9, 2020

    Update: I went with this one https://www.amazon.com/gp/product/B07H41HV6P/ref=ppx_yo_dt_b_asin_title_o04_s00?ie=UTF8&psc=1.

    The materials and construction are the same as the recommended brands, but it’s got 1in large compartment space in the length and width directions, as compared to most of the other bags.

    I went with the larger bag for a few reasons:

    1. I’m 6’4” and my thigh can easily accommodate a 9” pack, so I should maximize my capability.
    2. I’m a doctor so people expect me to treat things, which means having more of one thing or additional types of things, as compared to the layperson.

     
• 8

  ITWOP - March 9, 2020

  Is there a clear advantage to carrying the medications (acetaminophen, ibuprofen, etc) in liquid vs pill vs chewable form? I’d think liquid is easier to administer to weakened partners, but weighs more and take more space. Perhaps one form has a longer shelf life? Anything else for the average person to consider?

   
  • 15

    SpaceSnaxxx - March 9, 2020

    Here are my suggestions (I’m a physician and I’m certified in Advanced Wilderness Life Support):

    -Oral Dissolving Tablet (ODT)/Sublingual formulation: awesome but is the most difficult to obtain and not all medications are offered in this formulation. Offers rapid administration and are usually stored in blister packs. I prefer ODT for medications that are important to give when the patient is nauseous/vomiting (traditional oral medications might not stay down long enough to get absorbed). For example, I keep my Ondansetron 8mg ODT (brand name Zofran) to rapidly (<5 minutes) reduce nausea. I absolutely love Zofran, as a doctor and as a patient, but it’s a prescription medication, so you’ll need to get creative.If you know someone with “angina” you might be familiar with their “nitro” pills; these are also ODT.

    -“Chewable”: sort-of like ODT. I keep all of my Asprin (81mg) in chewable forms.

    -Tablet and Capsules: good because they are 1.) robust (don’t lose their form/turn into powder easily), 2.) retrievable (you can spill them and re-acquire them without loss of efficacy), 3.) don’t require a measuring tool (liquids need a cup), 4.) easily accessible, and 5.) are stable and easy to administer in a variety of settings. A problem I encountered when storing my tablets/capsule meds: I buy bulk if I can so I end up having to store the pills in a new container to save space/weight. The pills often don’t fit perfectly in my new containers so I pack them with cotton. This not only protects the pills from abrasion but keeps my bag quiet.

    -Liquid formulations: AVOID. These are difficult to measure without some kind of graduated container (which you might not have, or more likely has become dirty). Also, imagine if you tip over an open bottle…you can pick pills up, but you’re never going to separate your liquid Tylenol from the dirt.

    AVOID SPILLS, CHOOSE PILLS! (I just made that up…rhyming helps the brain remember things)

     
  • 10

    TraceContributor - March 9, 2020

    Great answer!

     
• 8

  M Grant - March 10, 2020

  Hi folks, many of the Amazon links are out of date, often pointing to other products.

   
  • 7

    John AdamaStaff - March 20, 2020

    Thanks for heads up. Doing best we can — COVID has a lot of stuff sold out.

     
  • 6

    John AdamaStaff - March 20, 2020

    [comment deleted]

     
• 8

  Kylie - March 27, 2020

  With item #20, plastic cling wrap, how did you cut it down to two inches? What did you use to cut it? Thanks!

   
  • 8

    Tom RaderStaff - March 27, 2020

    I just used a sharp kitchen knife and kind of sawed through it.  The end may be a little ragged but it works just fine.

     
  • 6

    NavyNuc - May 3, 2020

    A PVC pipe cutter works great, if you have one – just make sure it is big enough to handle your plastic wrap roll

     
  • 5

    Friend of the Pod - May 6, 2020

    

     
  • 7

    Alicia - January 23, 2021

    I used an electric knife that also worked for foam.  

     
• 11

  DocOnes - April 3, 2020

  Thank you for this article. It is awesome that you included the areas of debate!
  I also believe that a thermometer should be included. Not for a tactical kit necessarily, but these kits are meant to be accessible for any type of emergency, not just bugging out in a SHTF scenario. These kits will be included in the GHB, in cars, and many people will probably use it for reference to put in their camping gear.

  Also, in a bugout scenario, most people are extremely afraid to go to medical locations because they may be avoiding places where people are congregated, government intervention, driving back into a city, or a pandemic. I know this personally from being a medic in New Orleans after Hurricane Katrina. They need to know when it becomes necessary to go, and not put it off for too long.

  I highly recommend 3 Nextemp disposable thermometers.

   
• 5

  mike1911 - April 5, 2020

  Is it better to build your own kit or buy a pre-made kit?  Is there a pre-made kit you can recommend that won’t break the bank at the same time?

   
  • 9

    Tom RaderStaff - April 6, 2020

    IMO it is always better to build your own for a couple of reasons.  First, you know you, so you can tailor the kit to your needs and situation.

    Pre-made kits are generally put together to hit a price point, or to include some specific piece of gear that the builder has a relationship with. Most of the time you end up with some stuff you don’t need (or won’t ever use) so it is just taking up space, and also which factored into the cost.

    A decent starter kit is the AMK Explorer (https://theprepared.com/pick/g-ifak-adventure-medical-kits-mountain-series-explorer-medical-kit-rei/), but you should still supplement with a few other pieces (like a tourniquet, chest seal, large cravat, and aluminum splint; recommendations above in article).

     
• 6

  kurthgirl - April 9, 2020

  Any suggestions for a substitute for the Fox Outdoor First Responder Active Field Pouch? They seem to be sold out and back ordered. thanks

   
  • 8

    Friend of the Pod - April 9, 2020

    I used the one in the link below. It seems to be identical to the Fox Outdoor pouch.

     
  • 7

    Tom RaderStaff - April 9, 2020

    A recent one we have been playing with is the Lightning X IFAK Pouch (https://theprepared.com/pick/g-ifak-lightning-x-ifak-accessory-pouch-amzn/)  It has the right dimensions, and fits everything the Fox Outdoor goes (with the exception that it doesn’t have the tear away mesh pouch.

    It was snug at first, but the material stretched nicely.

     
  • 10

    Spazstick87 - April 24, 2020

    I am working to put together a couple of the level 3 kits after researching other lists and forums. This  list is extremely comprehensive and everyone who I show it to in the medical field is extremely impressed with how well the list is compiled.  I have several items on order currently and went to pull the trigger on the Fox pouch however they are on backorder due to high demand.  My question is after having the Lightning XIFAK pouch for a few weeks now do you believe this would still be a good bag for these kits?

     
  • 6

    Tom RaderStaff - April 24, 2020

    I think the Lightning X IFAK Pouch is a good bag.  It doesn’t have as many separate areas for stuff as the Fox ( I really like to organize), but it is workable and it holds everything the Fox does.

    I just ordered a new med bag from 5.11 (Med Gear Set) that looks promising, and I will update here if that passes muster–though it looks pretty big.

     
  • 5

    BigOldBear - May 6, 2020

    Curious about your evaluation of that 5.11 med bag ? I’m currently building my level III, and had been looking at that bag.

     
  • 6

    Tom RaderStaff - May 12, 2020

    The 5.11 Med Gear Set is HUGE.  It was way larger than I had envisioned.  I’ll get some pics and post here after I reload it (I filled it with the first aid stuff, then switched back to the Lightning X without taking pictures).  One downside is that it only comes in black, and doesn’t match the gray of my AMP 72.

     
  • 4

    Prepless in Seattle - September 30, 2020

    Hi Tom, do you have pics of this setup? I’m looking to pack my first IFAKs and trying to pick the right bags.

     
• 5

  NavyNuc - May 3, 2020

  https://deployedmedicine.com/ is a fantastic free resource. This is the official site of the U.S. military’s TCCC (tactical combat casualty care) training. The Level 1 / All Service Member course is a  good start for most rational preppers. Lots of pocket guides, curriculum, and videos, etc. All U.S. military service branches are transitioning to this curriculum, born out of the lessons learned in Iraq, Afghanistan, etc.

   
• 8

  Clark Thompson - May 6, 2020

  With the pandemic I’ve been spending a lot of time on trails around my house and a recent encounter caused me to change my own PFAK. I am not suggesting any of the priorities here (weight and lifesaving value) are wrong. But recently I met a couple in the woods where the young lady had twisted her ankle and was in serious pain, not shocky but not looking great either, with her male partner having to help carry her off the trail. They were close to the trailhead when I met them and refused help. But based on this encounter, and realizing that even with high boots an ankle sprain could put me in a bad situation I’d want cold and compression to deal with, I’ve subbed a 4” ace bandage (I had a 2”) and added a cold pack to my kit. The cold pack adds space and weight, and I wouldn’t take anything out of my basic kit but there’s room in my day pack. Here’s my thinking: is a twisted ankle more likely than a GSW most days in the woods? I’m packing it, and if the only service it does it to chill a beer when it expires and I replace it with a new one, I’m good with that.

   
  • 4

    Ef Rodriguez - May 6, 2020

    Thanks for sharing and it’s great that you’ve been thoughtful about how to customize these frameworks to make sense for you!

     
  • 9

    Keith Long - May 7, 2020

    I’ve seen posts in the past asking for suggestions on how to best pack these suggested kits.  For those of us not on FB, is the entry, or video, on how to pack yet?

     

     
  • 5

    Alicia - July 9, 2020

    The cold pack is definitely a benefit for the ‘less than bugout’ situations.  I’ve provided them at sporting matches several times since both of the items you mention are always in my equipment bag (softball, volleyball, etc).  So I have one in my FAK for the GHB as it covers some of these situations as well.  Words of caution:  I was stuffing my FAK and found that I’d ‘popped’ one of the instant cold packs in my efforts to get it all in; when they’re hot (as stored in the car) they don’t get as cold so not as beneficial.

     
  • 7

    Clark Thompson - July 9, 2020

    Having thought about this, the ice pack (despite the size, weight and fact it can pop) isn’t just a “less than bugout” essential to me. I’ve probably used more disposable ice packs than anything other than bandaids over the years. If it’s my ankle that turned, I’m not bugging out without RICE. Still not sure where it goes on the list, but anytime I’m somewhere I need to be able to walk out to get to where I need to go, I’m packing one. Wrapped in a bandana or shemagh depending on time of year.

     
  • 5

    Alicia - July 10, 2020

    I called it ‘less than bugout’ as in the situations where I’ve used them, the patient could easily get to better care including continued cold compress cycles.  And I certainly agree that it is one item I’ve used more often than others and had a similar question.  Sorry that wasn’t as clear.    I’m very curious as to the rationale this panel of experts didn’t include one as I certainly am no expert.

     
  • 5

    Clark Thompson - July 10, 2020

    My gut is it’s a size and weight trade off v prioritization of other gear that’s either more versatile or more suitable to immediate life saving. Could I save a life with an ice pack? If the ice pack means being able to continue moving away from an unsafe situation toward safety, maybe. But would I trade an ice pack for a tourniquet if weight was my primary? No. But do I carry a TK in my woods pack? No, I carry a couple triangle bandages I can improvise one with a stick, but I’m willing to trade that speed for the ice pack. (Where I am sticks are always readily available: in arid regions I’d pack a TK. I’ll admit that I’d put the ice pack on the list above chest seals unless I was going to Somalia or maybe Baltimore.

     
  • 7

    Tom RaderStaff - July 10, 2020

    Hi Alicia and Clark, I can address this as one of the authors.  Cold packs were specifically left out from this list because of three reasons.

    • They are one-shot devices that only last 20 minutes or so.  RICE protocol is that you apply the “ice” every 2-3 hours for 24-48 hours.  Carrying eight to twenty-four ice packs is not really feasible.
    • They are fragile.  Since they are designed to activate on impact, they can be triggered inadvertently–especially in more densely packed kits.
    • The purpose of the ice is to reduce swelling and pain.  Which is handled by the Ibuprofen (or whichever NSAID is right for you).

    As a general rule, there are better ways to manage that type of injury that provide for longer-term care management and utilize a more stable (and smaller) product.

    Keep in mind that RICE involves Rest and Elevation along with the Ice and Compression.  So if you are walking out with just an ice pack ace-wrapped to your ankle you are really not getting the benefit of the RICE protocol.  What you are really doing is managing pain (which comes from the swelling tissues).  And that can be handled with the ibuprofen.

    Also, there is some evidence that RICE (including the use of NSAIDS) delays healing.  It gives short term pain relief at the expense of disrupting the healing factors that are part of the swelling process.

    Ultimately this list is a suggestion based on a consensus of best practices.  That said, none of us had cold packs on our initial submissions for items on this list.  If ice packs work for you, and you are willing to carry them, by all means, do so!

     
  • 6

    Clark Thompson - July 11, 2020

    Tom, many thanks for this explanation. Makes a lot of sense.

     
• 10

  hankstom - May 23, 2020

  Worth noting that a good amount of items in the list are FSA eligible.

   
• 3

  Daniel Filan - June 9, 2020

  FYI the link to the “H&H combat cravat” now goes to a posture corrector, I can’t seem to find the combat cavat online for sale any more.

   
  • 7

    Michelle_B - July 14, 2020

    I just bought mine on Amazon here: https://www.amazon.com/gp/product/B010OUKSOI/ref=ppx_yo_dt_b_asin_title_o04_s00?ie=UTF8&psc=1

     
• 7

  isaiah cruz - September 22, 2020

  Can somebody provide the link to the packing tutorial? Having trouble figuring out how to fit everything 

   
  • 6

    Ef Rodriguez - September 22, 2020

    We haven’t made a packing tutorial [yet], but there’s a great forum thread about it here:

    https://theprepared.com/forum/thread/packing-a-first-aid-kit-ifak-discussion/

    I hope that’s helpful!

     
  • 7

    isaiah cruz - September 22, 2020

    Definitely! How would the pelican case fit in all of this? Looking like inside is not gonna happen so where on the outside? Or would it be inside the actual bag rather than the ifak?

     
  • 7

    Ef Rodriguez - September 22, 2020

    Exactly — in the actual bag. Obviously customize it however you like, but that’s the general idea since Pelicans can be big and rigid.

    Tom mentions the Pelican 1040 specifically in a comment further down the thread.

     
• 4

  Radical O'Pathy - September 25, 2020

  Dear Staff at The Prepared,

  Thank you for offering such a resourceful guide for those of us new to prepping. As an FYI, I’d like to bring to your attention that your link under the H and H cravat leads to this https://www.amazon.com/o/ASIN/B007Y1FDJ6/g-ifak-20 on Amazon. Also, in more places on the web it seems to be a burn injury dressing. Is that what you intended to have this included for, because it might double as a cravat AND a burn dressing? Or should we be looking at a separate cravat bandage for our kits?

  Please advise. 

  Thanks, and best wishes to all on the team during these trying times we are all living in.

  Soon-to-be-a-pro-prepper.

   
  • 9

    Tom RaderStaff - September 25, 2020

    Hi Radical, sorry about the bad link.  Amazon can be frustrating when they switch products on IDs like that.  I was able to locate more of the dressings at eBay actually (and I updated the broken link in the article–thanks for pointing it out!).  This product are getting more scarce because of the shipping and supply problems we are seeing.

    We chose that specific dressing because it is an XL Cravat.  It is also marketed a burn dressing because it is non-adherent to wounds.  It also comes with 2 large safety pins and a rubber band which can be used in other places in your kit.  When possible we try to recommend products that can be used in multiple ways.

    In my personal kit I carry 3 smaller cravats just because they are so useful.  When I go super minimal I always have a shemaugh, which can fill the role of a cravat as needed. 

     
• 4

  GrizzlyAK - October 3, 2020

  I really appreciate the thought put into this article (and others on ThePrepared), the additional details on the use of some of the products where appropriate, and the ending discussion on how you debated some of the items you left out and why. It instills a level of confidence that the advice given is solid, not some journalist blogger listing off the products they get some financial advantage from (i.e., “The Best IFAK for 2020” consisting of just a list of items). Thanks.

   
• 10

  Bob - December 5, 2020

  I lost my referenced article.  Apology.

  Somewhere here or nearby is mentioned at bug-out bags/guides … bag list, at: customize (believe this is subentry) re: iodine tablets … vital in a nuclear emergency

  https://www.cdc.gov/nceh/radiation/emergencies/ki.htm

  Above link to Centers For Disease Control provides a private citizen narrative on potassium iodide pills (KI pills).  This CDC link provides the current doctrine, unless there is something more current.

  Two points must be made:

  –  Only by evacuating to an emergency shelter with a clinic can one know if the area requires KI administration.  A private citizen just would not know and there are KI aspects not desirable if not required.

  –  This KI pill really requires planning in advance for those with children, young teens and certain others.

  ……

  I do ask for our medics’ review of this for current KI philosophy.

   
• 2

  Lowell - April 26, 2021

  CPR mask really only psychologically valuable? Modern guidelines skip rescue breathing altogether?

  From the article,

  CPR masks would’ve been on the list in the past, but modern guidelines are skipping mouth-to-mouth breathing altogether, making a mask moot. There are still a few wilderness medicine situations where rescue breathing is helpful — namely “correctable” situations like lightning strikes, drowning, asthma, etc. — but you’re most likely going to be with people you know, and thus aren’t as worried about random grossness. Besides, the mask is more about psychological comfort than an actual medical need anyway.

  Would you please elaborate on this? If I’m expecting to perform CPR on a random person (like someone unconscious on the street or in a store), is there still no medical motivation for a CPR mask?

  I just took an online Red Cross CPR/First Aid course, which did teach me to do rescue breathing. Will you please share more about why this should be skipped? Is the training I took outdated? Is performing the rescue breathing less effective than just chest compressions? 

   
  • 5

    Robert LarsonContributor - April 27, 2021

    While I’m no expert by any means, I can share my recent experience. From the last two CPR classes I’ve taken, both said not to do the breathing step and only do compressions. They said that the compressions are what saves lives and the time you take to stop and do the breathing will cut down on the amount of compressions you can do. They also taught that the action of the compressions forces air in and out of the body to a minimal amount. 

    In those classes I learned that the CPR mask is only for convenience and to help people feel more likely to overcome the grossness of touching lips of someone else. Guess people weren’t doing that step because they didn’t want to ‘kiss’ someone else. Also if the person vomits it can prevent some of that from regurgitating back into your mouth. 

    For me, if I were going to do rescue breaths like in the case of a drowning victim, I am not going to dig into my bag for a mask and mess around trying to put it on, I’m going to go straight to working on the victim, I can mouth wash later.

     
  • 4

    Lowell - April 27, 2021

    Thank you for your response Robert! I’ll cancel my CPR mask order for now, and hope I get even more clarity on “chest compressions only” by the time I need to do CPR! 

     
  • 8

    Tom RaderStaff - April 27, 2021

    I can concur with Robert.  Civilian urban CPR is moving to the compression-only variety.  Basically every time you stop compressions to breathe you are losing the blood pressure you have just built up, and blood pressure is the whole reason to do CPR–you are trying to keep the brain perfused with oxygenated blood.

    We have learned that there is actually enough residual oxygen in the blood for a long while and additionally if doing good compressions (which includes the release of the chest) you are creating a negative pressure in the lungs which will draw in the fresh air.  That amount being pulled in is enough to oxygenate the blood for the purposes of CPR.

    The reality is that without early access to cardiac medications and electricity and a Cath lab in a hospital, CPR survivability is low, especially in austere settings.  The best chance of getting someone back is when the heart itself is in good shape but was temporarily disrupted like from a lightning strike or drowning.  If the heart failure was from a life of too many cheeseburgers or from trauma to the heart itself the underlying cause is not fixable without advanced professional care.

    Rescue breathing in an austere setting is pretty fixable, assuming the person has a pulse.  In that case, a mask can help if you have issues with mouth to mouth with no barrier.  But you don’t need a big sealable mask–there are plenty of small barrier masks which are nothing more than a sheet of plastic with a filter.  Cheap and light solution.

     
  • 8

    Friend of the Pod - April 27, 2021

    I can concur w/ regard to compression-only CPR too, not from a class, but from having been instructed by a 911 operator during an emergency. I don’t know if they tell people about this in classes, but the thing you really need to prepare yourself for psychologically is the feeling of the other person’s ribs cracking under your hands when you start compressions. That haunted me for weeks.

     
  • 9

    Clark Thompson - April 27, 2021

    As former EMT I concur. With an elderly patient With brittle bones it’s not uncommon for the entire sternum to eventually completely break loose from the ribs on compression, and you then have to be really careful not to compress so hard the ribs come through the skin. The dummies in CPR class don’t help you figure out how much is too much.

     
  • 4

    Robert LarsonContributor - April 27, 2021

    Breaking ribs and risking them popping through the skin would give me nightmares! Thank you for telling me about that now so I can start to try and mentally overcome that hurdle.

     
  • 5

    Lowell - April 27, 2021

    Re: rib breaking – I haven’t administered CPR yet, but I’ve read that folks often don’t push hard enough for fear of this. Broken ribs aren’t as big of a deal as pushing too softly for effective CPR. The Red Cross guidance is “If you remember anything, push *hard* and *fast*” (for adults: 100-120 bpm, depth of at least 2 inches)

     
  • 6

    Tom RaderStaff - April 27, 2021

    Painfully, Baby Shark (as well as Stayin Alive and Another One Bites the Dust) have the right cadence for CPR:

     
  • 5

    Lowell - April 27, 2021

    Stayin Alive: https://youtu.be/Vmb1tqYqyII 

     
  • 2

    Robert LarsonContributor - April 27, 2021

    THIS!!! Best scene of the entire series!

     
  • 6

    Robert LarsonContributor - April 27, 2021

    If anyone  resuscitated me to Baby Shark, I probably would pass out again….

     
  • 2

    Alicia - April 27, 2021

    I updated my CPR a few months before covid.  They stated no compressions, included practice with an auto-defibrillator and used Staying Alive as a cadence indicator.   Baby Shark speeds up at the end…..hmmmm.  

     
  • 4

    John AdamaStaff - April 28, 2021

    I love how many medical professionals are concurring with each other in this thread 

     
  • 1

    Jim Piper - July 14, 2022

    Before retiring I had been involved in probably a dozen “codes” on our telemetry-medical unit. In none of the cases were any ribs broken. IMHO, proper hand placement will not yield bone breaks, but perhaps for a geriatric patient afflicted with a calcium deficiency.

     
  • 2

    TraceContributor - December 1, 2021

    When I would teach CPR, I would start off reminding students that you only do full CPR on someone who is DEAD, not unconscious or unresponsive. 

    And agreeing (again) with Tom, CPR in an austere environment is only going to work on someone who’s heart stopped because of electricity, or drowning. I would also include kids — if kids arrest it’s typically because of choking and CPR can be very effective. 

    When doing breathing “random grossness” is a thing. If you don’t have the head positioned correctly (even when non intubated bagging) and the air is going into their stomach, they are going to vomit it back up bringing up anything contained in there. It is gross, and common. 

     
  • 3

    Jim Piper - July 14, 2022

    In an austere environment where EMS is either seriously delayed or or simply not coming, I think one would need to seriously consider whether or not to begin CPR on a patient who is determined to be in cardiac arrest (i.e., no detectable pulse. Alternatively one could begin one or two rounds of compressions and, if the patient doesn’t respond in any fashion, cease further efforts.

    (I note that in the codes in which I’ve been involved, albeit an acute care setting, compressions were started on patients discovered to be in arrest for only a very short time. More than several began fighting after only one set of compressions.)

    — RN (ret.)

     
  • 1

    Robert LarsonContributor - July 14, 2022

    Jim – So from your experience, we should try for two rounds of compressions and if they don’t respond to that they are most likely not going to respond to further?

     
  • 2

    Jim Piper - July 14, 2022

    It’s a judgement call based on dependencies:

    • In an austere environment:  EMS expected with all their rescue toys? Response time?
    • Fatigue factor for rescuer (professionals whether BLS or ACLS, are trained to switch off from compressions every two minutes, i.e., two full cycles. Doing compressions to the depth and rate required is v-e-r-y fatiguing. If help isn’t on the way, it’s harsh, but, I’d let a victim go after only a few cycles.
    • Depending on long the victim has been down plus his/her co-morbidities affects potential for recovery. Catch a victim early on (like you saw him/her fall), enhances chance of survival. Time is brain.

    Consider that an austere environment doesn’t have to be an EOTWAWKI scenario, it can be hiking out the deep boonies where rescue might be measured in many hours.

    Back in the day when I got my Red Cross “Emergency Responder” training a story was told where some Boy Scouts were out in the boonies in the central Calif coastal range and their scoutmaster went down. They did CPR for a couple of hours before rescue and he survived. An outlier event, to be sure.

     
  • 1

    Robert LarsonContributor - July 14, 2022

    Thank you for your answer. I’m sure that scoutmaster’s chest was very sore after hours of compressions, but wonderful that he survived. Each boy who helped should have been given an honorary first aid merit badge without having to do any other requirements.

     
  • 2

    Jim Piper - July 14, 2022

    I wish I knew more details, but they were thin at the time.

     
• 4

  mike1911 - June 6, 2021

  I picked up a NAR MFAK from Primary Arms on sale recently.
  It comes with:
  1x CAT Tourniquet
  2x Hyfin Vent chest seals
  1x S rolled gauze
  1x Emergency Trauma Dressing
  1x gloves

  I want to add some Tylenol but there’s not much free space left. I could probably fit a few pills in a small bag or something, but what kind of bag to use? Will like a ziploc bag work or is there a better way to store them?

   
  • 2

    Lowell - June 6, 2021

    I think a ziploc would be fine, but you could also get these “Pill Packs” that are very small and also have a part where you can write the medication & dosage on the baggie

     
  • 2

    MainPugh - June 6, 2021

    I’m using those, too!

     
  • 1

    Bob - June 6, 2021

    Good afternoon Mike 1911,

    In reply only to what kind of bag, I know my Tylenol 3 and 4 are light-sensitive and must be kept in opaque type of container. There are Ziplock (don’t know if the actually famous brand) type of bags in various colors to include black.

     
  • 4

    Clark Thompson - June 6, 2021

    Small ziplock is a cheap option, add a cotton ball above and then below for cushioning then wrap in heavy duty tinfoil. Tylenol is “relatively” crush proof but I’ve had aspirin and pepto tablets turn to powder. Alternatively there are number of key fob pill containers on Amazon you could attach to the bag at a zipper with some 550 or with a Safety pin anywhere…

     
  • 2

    Alicia - June 6, 2021

    I started with these small waterproof plano boxes with the ziplocs inside and then moved them to a  small Pelican case  because it’s stronger (but heavier) and I could fit it.  

     
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    Olly Wright - June 7, 2021

    Those pelican cases look like a worthy upgrade even if they are heavier. I tend to like heavier duty things that will last longer, because I’d rather carry a bit more weight than have a crushed or popped container and then have nothing.

     
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    Alicia - June 7, 2021

    If you look at the photos of my kit, you’ll see I’ve taken advantage of compression in my packing.   The Gear Aid Field repair kit did suffer some deformation as it wasn’t strong enough.  So the Pelican is earning its keep for the meds.  I did not get the larger one that Tom Rader recommended as part of the iFAK because I could fit the topicals in my larger FAK pack (didn’t need the extra space)  and it didn’t fit into my bag well.

     
  • 4

    mike1911 - June 8, 2021

    I didn’t think about the pills getting crushed.  I may try the pill fobs. Otherwise I will need to upgrade to a bigger pouch.

     
  • 3

    Alicia - June 8, 2021

    The pelican isn’t in the FAK pouch.  It’s stored separately which is cheating a bit in my book.  For me its in the bottom of the shove pocket with the FAK on top of it.  So it’s still pretty accessible. 

     
• 3

  meta system - July 18, 2021

  Can someone tell me what product is used in the Level 2 example picture? I mean the red pouch attached to the backpack, with tourniquet and scissors. I’d also like to know if all the level 2 stuff fits in said red pouch since level 3 seemed to present some difficulties with its associated bag.

  Alternatively, can someone recommend a level 2 pouch? I want to have an everyday carry bag that’s not too large, preferably in red. Cheers!

   
  • 3

    Yasmin - July 18, 2021

    The pouch shown is the ITS ETA tallboy

     
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    Sir Henry - July 19, 2021

    I think that level 2 pouch is an ideal size for me as well, so thank you for pointing out what it’s called Yasmin. 

    I couldn’t find it on Amazon, but a Google search brought up a few sites that sell it like https://store.itstactical.com/products/its-eta-trauma-kit-pouch-tallboy

     
• 3

  Clark Thompson - September 3, 2021

  Folks— opinions and ideas welcome on a question. The 30+ year old M3 Medic bag knockoff I have used as my trauma kit is finally at the point where tape, glue and sewing can’t save it. Looking for options for replacement bags of similar size and capacity but ideally with some level transparency into the contents and more organization than three big pouches. My fallback, since I think 30 years is probably beyond reasonable expectations, is to replace it with another M3, but if anyone has suggestions for better (more water resistant, durable, accessible etc) please reply 

   
  • 3

    Gideon ParkerStaff - September 3, 2021

    Sounds like another M3 should last you for the rest of your life, but always good to see if there is anything better out there. 

    There was a recent forum thread about what case should we have for our first aid kit that might give you some ideas.

    Two pouches that members of The Prepared use are the 5.11 Tactical Med Pouch Gear Set and Fox Tactical First Responder Active Field Pouch

     
• 2

  Jeff - October 8, 2021

  I had heard that Doxycycline (and other -cyclines) are one of the few medications that become toxic when they age (as opposed to just becoming less effective).  If so, it would be important to monitor expiration dates and replace as required.

   
  • 2

    Clark Thompson - October 8, 2021

    For government emergency stockpiles of doxycycline the FDA extended the expiration beyond the then current six years past expiration date in 2019. So unless it’s beyond six years past expiration…https://www.raps.org/news-and-articles/news-articles/2019/4/fda-finalizes-guidance-on-extending-stockpiled-dox

     
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    TraceContributor - December 1, 2021

    Years ago I wrote a blog on just this topic. Shameless plug, that has (I believe) good information: https://tracemypreps.wordpress.com/2011/11/02/expired-or-not-expired-that-is-the-question/

    Specifically about -cyclines (taken from my post): 

    Dealing With The ‘Tetracycline Becomes Toxic’ Myth

    There has long been a belief that the antibiotic tetracycline becomes toxic once it has past it’s expiration date.

    In Medscape Today’s article, Do Medications Really Expire?, they discusses the original case, “A contested example of a rare exception [of expired drugs possibly becoming toxic] is a case of renal tubular damage purportedly caused by expired tetracycline (reported by G. W. Frimpter and colleagues in JAMA, 1963;184:111). This outcome (disputed by other scientists) was supposedly caused by a chemical transformation of the active ingredient.”

    The case was thoroughly evaluated in the 1978 article, Tetracycline in a Renal Insufficiency: Resolution of a Therapeutic Dilemma, it states, “”Old” and degraded tetracyclines have previously been demonstrated to have direct toxic effects on the renal proximal tubule, but because of changes in manufacturing techniques this is no longer a real problem.” It also states, “It has often been stated that the tetracyclines should be avoided in patients with severe renal disease, but, as we shall see, doxycycline represents an important exception to the rule”.

    In Cohen’s article on the Shelf Life Extension Program, Many Medicines Are Potent Years Past Expiration Dates, it goes on to state, “Only one report known to the medical community linked an old drug to human toxicity. A 1963 Journal of the American Medical Association article said degraded tetracycline caused kidney damage. Even this study, though, has been challenged by other scientists. Mr. Flaherty says the Shelf Life program encountered no toxicity with tetracycline”.

    Dr. Bones and Nurse Amy, from The Doom and Bloom Show, when interviewed on TSP, clearly state that tetracycline past it’s expiration date is safe (episode 736, beginning at 43:45). Nurse Amy concludes the topic with “. . . if they can just get that in their heads that tetracycline isn’t going to kill you when it’s past expiration”.

    Medical evidence supports that tetracycline, past it’s expiration date–especially in the form of doxycycline–is as safe as any other expired antibiotic.

     
• 3

  John AdamaStaff - December 1, 2021

  Sharing this comment from a friend about the “chest darts” / decompression needles and why TP doesn’t recommend them: 

  “Just for a little perspective: In nearly 30 years as an urban paramedic, I have darted a chest exactly ONE TIME. As a Quality Improvement Officer that had to review all chest darts for 200 urban paramedics, I reviewed about 3 per year and 2 per year had complications and/or caused harm. They can be a life saving tool, but only in very rare correctly diagnosed cases and when performed correctly.”

   
  • 3

    TraceContributor - December 1, 2021

    I completely agree. As a military medic then a civilian paramedic for 10+ years, I never darted a chest. Sure we had them, and in that environment we should. But it a portable kit, they are an overly specialized piece of equipment that takes up space that can be used for more common problems/injuries. (I do not have them in mine.)

     
• 2

  Charlie - March 29, 2022

  What type or brand of pouch would you put a level 3 kit in? I see the a pic of a “8 x 6″ x 4” molle pouch.  Did you start with a standard medical kit that came in this pouch and modify, or are their companies that make these “empty” pouches?  Thanks!

   
• 2

  Jim Piper - July 14, 2022

  One thing I see chronically missing (and maybe I missed it in the description and discussion of the first aid kits) is a strong recommendation to get training in first aid, First Responder at a minimum, better EMT-B, and/or wilderness first aid. Without the knowledge of how to treat wounds and recognize sick/not-sick, all the fandancy IFAKS in the world are worthless.

  I’ll add antiseptic procedures to avoid sepsis in an austere environment when medical help is either delayed or simply not coming.

  ‘jus sayin’ for a friend …

  — Retired RN and former member NDMS DMAT-11.

   
  • 1

    Robert LarsonContributor - July 14, 2022

    I took a trauma first aid course and learned how to use things such as chest seals, tourniquets, and packing a wound and even after that I don’t feel very comfortable knowing how to use all of the gear in an IFAK. I need to do further training.

     
  • 2

    Jim Piper - July 14, 2022

    Given the prevalence of gun violence today I think a minimum of a “Stop The Bleed” course and kit plus BLS CPR course would be prudent. I’ve recently gotten off my butt and put together several “STB” kits so that I have one within reach, just in case (I hope the hell I never have to use one).

    Back in the day one my first advanced FA course instructors was a paramedic who told us that we could never have enough 4x4s.

    I’ve gotten lost in these threads and don’t remember if I suggested a wilderness first aid course. A “Emergency Responder” course if the Red Cross still teaches it, a “First Responder”, or an EMT-B course are good starts. BUT, their taught from the perspective that EMS is on the way with all their toys. The wilderness FA courses are from the perspective that EMS will be significantly delayed.

    https://www.nols.edu/en/wilderness-medicine/courses/get-certified/

    Having corresponded with Dr. Alton on numerous occasions, I have the confidence he and his ARNP spouse Amy offer classes that should be exellent:
    

    Medical Classes

    best regards

    — Jim